EFFECTS OF ORAL ERYTHROMYCIN ON FASTING AND POSTPRANDIAL ANTRODUODENAL MOTILITY IN PATIENTS WITH TYPE-I DIABETES, MEASURED WITH AN AMBULATORY MANOMETRIC TECHNIQUE

OBJECTIVE - The aim of this double-blind crossover study was to evalua te the effects of oral erythromycin (250 mg t.i.d.) on fasting and pos tprandial gastrointestinal motility and gastrointestinal symptoms in p atients with type I diabetes. RESEARCH DESIGN AND METHODS - Antroduode nal motility was recorded with an ambulatory manometric technique for a 20-h period, including a high-caloric high-fat dinner and a low-calo ric low-fat breakfast and a long fasting period, after 2 weeks erythro mycin and placebo treatment in 12 patients with type I diabetes. Durin g the manometric study, plasma glucose concentrations were assessed by frequent self-testing. Gastrointestinal symptoms were scored daily to assess the severity of the symptoms (range 0-3). RESULTS - Oral eryth romycin decreased the migrating motor complex cycle length from 118.9 +/- 46.0 to 86.2 +/- 25.3 min (P = 0.03) by shortening phase II from 6 8.7 +/- 23.5 to 48.5 +/- 19.4 min (P < 0.05). The total number of duod enal phase III increased from 48 to 62 (P = 0.075). However, the degre e of antral participation to duodenal phase III did not increase. Eryt hromycin significantly decreased the duration of the postprandial peri od after dinner (from 417.0 +/- 137.9 to 348.8 +/- 93.8 min, P = 0.04) . During this shorter postprandial period, the number of antral contra ctions (P < 0.01) and the antral motility index increased (P < 0.03), and early phase III activity at the level of the duodenum was abolishe d. In diabetic patients with antral hypomotility, after dinner, the me an symptom score improved significantly, from 2.07 +/- 0.86 to 1.52 +/ - 0.63 (P = 0.018). CONCLUSIONS - This ambulatory antroduodenal manome tric study showed that oral erythromycin (250 mg t.i.d.) improves both fasting and postprandial antroduodenal motor activity after a high-ca loric meal in patients with type I diabetes. Furthermore, in diabetic subjects with postprandial antral hypomotility, erythromycin reduces d yspeptic symptoms.